title: Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile.
  
  
  METHODS
  Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed.
  
  
  RESULTS
  From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant weighted mean difference (WMD) for hsCRP (-0.50 mg/l, 95% CI:-0.78; -0.22), IL-6 (-0.48 ng/l, 95% CI: -0.90; -0.06), TNF-α (-0.75 pg/ml, 95% CI: -1.34; -0.17), fibrinogen (-0.47 g/l, 95% CI: -0.76; -0.17), total cholesterol (-0.11 mmol/l, 95% CI: -0.21; -0.01) and HDL-C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (-0.71 mg/l, 95% CI: -1.05; -0.36), IL-6 (-0.87 ng/l, 95% CI: -0.97; -0.78), triglycerides (-0.24 mmol/l, 95% CI: -0.26; -0.22), total cholesterol (-0.15 mmol/l, 95% CI: -0.29; -0.01), HDL-C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA1c (-0.43%, 95% CI: -0.60; -0.25).
  
  
  CONCLUSIONS
  This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wijnand J
authors.initials: WJ
authors.lastname: Teeuw
authors.forename: Dagmar E
authors.initials: DE
authors.lastname: Slot
authors.forename: Hendri
authors.initials: H
authors.lastname: Susanto
authors.forename: Victor E A
authors.initials: VE
authors.lastname: Gerdes
authors.forename: Frank
authors.initials: F
authors.lastname: Abbas
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Aiuto
authors.forename: John J P
authors.initials: JJ
authors.lastname: Kastelein
authors.forename: Bruno G
authors.initials: BG
authors.lastname: Loos
mesh_terms: D050197:Atherosclerosis / Q000097:blood / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D010518:Periodontitis / Q000628:therapy*; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: atherosclerosis; periodontitis; systematic review; therapy